How do physicians feel about the affiliation with OHSU? What new possibilities do they see resulting from the new relationship with OHSU? Watch this video to learn their answers to these and other questions.

The next issue of Common Ground will include a recap of the questions and answers from the recent forums. If you were unable to attend and have questions you would like to see addressed, please submit questions to commonground@salemhealth.org.

The current policy for privileging licensed independent practitioners in a disaster does not meet Joint Commission Emergency Management standards. Changes are being proposed to the Medical Staff Bylaws and Credentials Procedure Manual to bring the policy into compliance. Read the details of the proposed changes.

First thing to remember: document to the required specificity. Your documentation is required to support the SOI (severity of illness), length of stay (LOS), risk of mortality (ROM) and to support the codes that need to be assigned. Codes will be 'built' and if a piece is missing, there will be no code available. Coders cannot code from lab values, past chart notes, imaging studies, path reports, etc. They code from your documentation.

Manifestation: TB may manifest as disease of lung, pericardium, meningitis, skeleton, genitourinary, etc. These should be documented.

Tobacco, alcohol and drug status: For example, nicotine dependence takes a more prominent role with further subcategories for specific type of tobacco product used and if in withdrawal, or if abuse is associated with a condition (CAD or COPD associated with 40 pack/year smoking).

Additional tips:

Stroke: Need to document patient's dominant side and whether affected.

Episode of care: Designate the episode of care as initial or subsequent for injuries. It is the new seventh digit in the diagnosis code and it is not specific for outpatient only. More to come on this one.

Patient condition: Document if mild, moderate, severe, critical, guarded, etc. For example, asthma and malnutrition are documented as mild, moderate or severe. Remove 'A & O x 3, in NAD' from your template. It can negate much of your documentation on sick patients when it appears they do not look ill to their attending.

Compression fractures: Any time that you document 'compression fracture', we need to know if it is traumatic or pathological. If pathological, is it initial, is it healing but still being treated (i.e. with pain meds), or healed and not being treated? We also need documentation of the etiology of pathological fractures. There are now combination codes for pathological fractures due to osteoporosis.

Urosepsis will no longer have a code-remove from your vocabulary.

Preserved ejection fraction does not have a code in ICD-10 either. We still have to document diastolic heart failure.

Pain: Document the location, laterality, acuity, if suspected to be psychological, and what caused the pain.

Afib and flutter each have their own code and are not interchangeable. If both exist intermittently, must say so, otherwise, document the one most appropriate condition.

HIV/AIDS: These are not synonymous. A patient may have HIV infection but not AIDS, but if a patient has ever had an AIDS defining illness, that patient has AIDS from then on. It must be documented as AIDS on every admission.

Glasgow Coma Scale: Documentation must include three key elements: eye response, verbal response and motor response. Coders can get much of this information from nurses' notes, physical exam, etc., but only the physician can document the injury or condition underlying the mental status changes.

As promised, the Salem Health Star Awards program resumed service Sept. 1, 2015!

Look for the Star Awards link in the lower right corner of the Salem Health intranet home screen. The nomination link was re-activated on Sept. 1. All of the wonderful stories of the great actions and people who bring their talents to this organization can be shared once more.

Remember, this recognition system can be used to show appreciation for individuals and teams. Volunteers, employees and members of the medical staff are all eligible.

The new system has a redesigned look, but will function similarly to the previous one. Nominations for the Stop-The-Line Award will also be submitted through the new link. This award is specifically for team members that displayed the courage to stop what is happening to make certain all we do is safe.

Beginning Sept. 14, 2015, the physician parking lot behind Building B will be closed so that NW Natural can install a new natural gas line through the north and west lots of Building B. Temporary parking will be available for physicians on the southwest corner of Winter Street. (This is the gravel lot on the construction site for the new outpatient rehabilitation building. Access is off Winter Street. Click here for a map.) After Sept. 28, a temporary traffic lane will be flagged open for physicians to return to the lot behind Building B. There will still be some construction during this time, so please use caution and watch for directional signage. Construction should wrap up by Oct. 2, 2015. Thank you for your patience during this time.

A change has been proposed to the Salem Hospital Medical Staff Rules & Regulations relating to treatment orders. The change is being recommended because of the recently revised and approved physician assistant privilege request form. Read the text of the proposed changes.

Effective Thursday, Aug. 27, IV promethazine is once again available for patients at Salem Hospital. To reduce the probability of harm from promethazine extravasation, the dose will be limited to 12.5 mg, each dose will be diluted in 100 mL of normal saline and it will be removed from order sets. This will ensure that promethazine continues to be safely available to the patients who need it the most.

There have been questions about the process that led to the temporary moratorium on IV promethazine. After an incident in NTCU which necessitated a plastic surgery consultation, and based on numerous case reports and recommendations for safer administration in the pharmaceutical literature, patient safety staff submitted a proposal to medical staff leadership to re-evaluate how (or if) we should continue to utilize IV promethazine. Due to meeting schedules, neither P&T nor MEC would be able to discuss the proposal for over a month. This led to the decision by Howard Cohen (P&T chair) to stop-the-line in the name of patient safety. This decision was made in collaboration with Rob Harder (medical executive committee member on call) and Mike Hanslits (president of the medical staff) on Saturday, June 27.

Once the moratorium was in place, the proposal was discussed at the July physician leadership meeting, at the August P&T committee meeting and then MEC during their second meeting in August. The reintroduction of IV promethazine, with alterations to enhance its safe delivery to patients, occurred shortly after the MEC meeting.

One of the most important lessons learned was about communication to the medical staff. In the future, stop-the-line issues will be communicated with medical and nursing staff with a more targeted word of mouth campaign, accompanying submission of an Urgent Common Ground and a RADAR message.

Julianne Brock, FNP-C, from Willamette Health Partners family medicine clinic in Keizer was recently featured promoting the Reach Out & Read program designed to improve early literacy. Read the Keizertimes article "Medical providers prescribe books for young children."